NAFLD & Obesity Assessment

Waist Circumference: A waist circumference greater than 88 cm in women is suggestive of obesity, increasing the likelihood of NAFLD.
Skin/Nails Exam: Signs of malnutrition, such as pallor, spider angiomas, caput medusae, or palmar erythema, increase the likelihood of NAFLD.
Fluid Ascites: Fluid ascites may be present in NAFLD due to portal hypertension.
Spleen Palpation: Hepatomegaly (liver enlargement) with a midclavicular liver span greater than 10 cm is suggestive and increases the likelihood of the condition.
Normal midclavicular liver span is 6-12 cm.
Liver Palpation: Mild discomfort during palpation, or a palpable liver edge, would increase the likelihood of NAFLD.
A normal liver edge should be slightly tender, or nonpalpable.

Neck Circumference: A neck circumference greater than 40 cm increases the likelihood of obesity.
Waist Circumference: A waist circumference greater than 89 cm in women is indicative of obesity.
Skin Exam: Fatty deposits around the eyes and beefy red rashes in folds increase the likelihood of obesity.
Blood Pressure: High blood pressure may be a factor.

Skin Exam: Jaundice and reduced body hair increase the likelihood
Liver Palpation: Pain during palpation or a hard, non-palpable edge may suggest the condition.

Fluid Ascites: Fluid ascites is positive in liver failure due to portal hypertension.
Skin Exam: Jaundice

Skin Exam: Acanthosis nigricans (darkening of skin), eruptive xanthomas, non-healing wounds, and foot ulcers may be suggestive.
Ophthalmoscopic Exam: Cotton wool spots, macular edema, glaucoma, or cataracts may be present.

Painful Arc Test: Pain between 60-120 degrees suggests supraspinatus involvement.
External Rotation Lag Sign: Suggests infraspinatus or supraspinatus involvement.
Internal Rotation Lag Sign: Suggests subscapularis involvement.
Drop arm Test: Sudden drop or weakness in the arm when painting out the arm in a particular position suggests supraspinatous involvement.

Thyroid Inspection/Palpation: Enlargement (goiter), tenderness, firm or hard consistency, or a palpable mass during palpation suggests hypothyroidism.
Nails and Hair: Dry, brittle, thin nails and thinning hair are potential signs.
Skin Exam: Cool, pale, or yellowing skin (carotenemia) or puffy face, and eyelids (suggesting periorbital edema) may suggest the condition
DTRs: Delayed patellar and Achilles reflexes (1+ instead of the normal 2+)
Heart Auscultation: Possible friction rub
Lung Exam: Wheezing may be present

Temperature: Hypothermic temperatures (<35.5°C) would suggest Myxedema coma.
Heart rate: A heart rate lower than 60 bpm but within the normal range of 60-100 bpm in Myxedema coma would typically be below 60 bpm.
Respiratory Rate: A rate less than 12-20 breaths per minute suggests hypoventilation.
Peripheral edema: Peripheral edema (non-pitting) that is graded above 0 is observed when examining the patient.

Lymph Node Palpation: Swollen and tender lymph nodes anywhere in the body suggest infection, while swollen and tender axillary lymph nodes may suggest cancer.
Abdominal Exam: Decreased or absent bowel sounds may indicate an obstruction from a mass.
Heart Auscultation: An S3 heart sound may indicate heart failure or arrhythmias

Neck Circumference: A neck circumference exceeding 40 cm increases the likelihood of sleep apnea.
Oropharyngeal Exam: Malle and palle measurements (2-4) increase the likelihood of sleep apnea.
Nose and Sinus Exam: Asymmetry or nasal obstructions (deformity, lesions, polyps, septal deviation) could indicate sleep apnea.

Blood Pressure: Hypertension is often present.
Peripheral Pulses: Asymmetrical pulses or a grade 0 (non-palpable) or 1 (slightly diminished) pulse may be observed.
Bruits: Vascular bruits are potentially present.
Skin Exam: Xanthomas or beefy red rash may be present.

Peripheral Pulses: Diminished or absent peripheral pulses, particularly posterior tibial pulse, femoral pulse, or dorsalis pedis pulse, are suggestive.
Skin Exam: Non-healing wounds on the lower extremities, and foot inspection may show ulcers between toes, related to ill-fitting footwear.

Nasal Exam: Erythema and edema, as well as purulent rhinorrhea, indicate rhinosinusitis, alongside obvious nasal obstruction.
Sinus Exam: Pain or pressure upon pressing on the sinuses.
Temperature: Fever (temperature > 37°C)

Head Trauma/Headaches: Presenting symptoms (along with potential neurological deficits such as visual acuity impairment, cranial nerves, etc)

Anemia (Nutritional Status Exam): Pale conjunctiva, pale nail beds, pale palms and hand creases, and pale tongue are indicators.
External eye exam should show no jaundice
Anterior rim should be full redness compared to posterior rim
Nail bed should be normal pink colour, palms should be slightly pink, tongue should be fleshy pink
Hair and nails (Brittle nails, Spoon use of nails), blood pressure (Hypotensive with systolic pressure less than 90 and diastolic less than 60)
Vascular Dementia: (Minicog). A score of 2 or less may indicate an increased risk for dementia, carotid bruits, blood pressure measurements and an eye exam.

Abdominal Palpation: Suprapubic pain detected during palpation, both deep and light palpation.
Temperature: Absence of fever.

CVA (Costovertebral Angle): Pain upon percussion.
Temperature: Presence of fever.
Vitals: Blood pressure could be hypotensive, indicating shock or sepsis, or hypertensive, and also heart tachycardia, and increased respiratory rate indicating tachypnea.